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1.
Annu Rev Entomol ; 69: 393-413, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-37758221

RESUMO

Mirids (Hemiptera: Heteroptera: Miridae) feed upon a wide variety of cultivated and wild plants and can be economically important crop pests. They have traditionally been perceived as innocuous herbivores in East Asia; however, population levels of various mirid species have dramatically increased over the past decades. High-profile pests such as Apolygus spp., Adelphocoris spp., and Lygus spp. are now widely distributed across the region, and their infestation pressure is associated with climate, agroecological conditions, and farming practices. This review outlines how an in-depth understanding of pest biology, a systems-level characterization of pest ecology, and a comprehensive evaluation of integrated pest management tactics have enabled sustainable management of mirids across crop boundaries and harvest cycles. This work underscores how more holistic, integrative research approaches can accelerate the implementation of area-wide management of generalist pests, effectively prevent pest population build-up and yield impact, and shrink the environmental footprint of agriculture. In addition to highlighting the merits of interdisciplinary systems approaches, we discuss prospects and challenges for the sustainable management of polyphagous mirid pests in landscape matrices.


Assuntos
Heterópteros , Animais , Ecologia , Controle de Pragas , Agricultura , Ásia Oriental
2.
BMC Med ; 22(1): 177, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38715000

RESUMO

BACKGROUND: Healthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow's milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme's effectiveness and uptake. METHODS: The study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi-structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non-government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants. RESULTS: Six core themes cut across stakeholders' perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child's right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels. CONCLUSIONS: HS provides benefits for child development and family wellbeing. The study's recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.


Assuntos
Pesquisa Qualitativa , Humanos , Inglaterra , Lactente , Feminino , Pré-Escolar , Masculino , Pobreza
3.
BMC Public Health ; 24(1): 2168, 2024 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-39127652

RESUMO

BACKGROUND: Addressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system's level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions. METHODS: In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach. RESULTS: Interviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system's approach to reducing health inequalities was evident as was collective action and involving people, with links to a "strong third sector". Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system. CONCLUSION: We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system's working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.


Assuntos
Pesquisa Qualitativa , Humanos , Reino Unido , Disparidades nos Níveis de Saúde , Estudos de Casos Organizacionais , Entrevistas como Assunto , Medicina Estatal/organização & administração , Atenção à Saúde/organização & administração , Disparidades em Assistência à Saúde , Desigualdades de Saúde
4.
BMC Public Health ; 24(1): 1376, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38778279

RESUMO

BACKGROUND: The small Atlantic island of St Helena is a United Kingdom Overseas Territory (UKOT) with a high prevalence of childhood obesity (over a quarter of 4-5 and 10-11 year olds) and, anecdotally, adulthood obesity and its associated health detriments. St Helena have taken a whole systems approach to obesity (WSAO) to address the issue. A WSAO recognises the factors that impact obesity as a complex system and requires a 'health in all policies' approach. UK academic and public health technical support was provided to the local St Helena delivery team. This process evaluation sought to explore the early stages of the WSAO implementation and implications for the transferability of the approach to other small island developing states and UKOT. METHODS: Data was collected via eight semi-structured interviews, paper based and online surveys, and document analysis. Thematic analysis was used to analyse the data. RESULTS: The analysis identified three factors which aided the first phase of WSAO implementation: (1) senior leaders support for the approach; (2) the academic support provided to establish and develop the approach; and (3) effective adaptation of UK Government resources to suit the local context. Key challenges of early implementation included: maintaining and broadening stakeholder engagement; limited local workforce capacity and baseline knowledge related to obesity and systems thinking; and limited capacity for support from the UK-based academic team due to contract terms and COVID-19 restrictions. CONCLUSIONS: Early stages of implementation of a WSAO in a UKOT can be successful when using UK's resources as a guide and adapting them to a small island context. All participants recommended other small islands adopt this approach. Continued senior support, dedicated leadership, and comprehensive community engagement is needed to progress implementation and provide the foundation for long-term impact. Small island developing states considering adopting a WSAO should consider political will, senior level buy-in and support, funding, and local workforce knowledge and capacity to enable the best chances of successful and sustainable implementation.


Assuntos
Obesidade Infantil , Humanos , Obesidade Infantil/epidemiologia , Reino Unido/epidemiologia , Criança , Obesidade/epidemiologia , Pré-Escolar , Avaliação de Programas e Projetos de Saúde
5.
BMC Med Educ ; 24(1): 244, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38448906

RESUMO

BACKGROUND: The systems approach has been used to evaluate higher education and explores inputs, transformation process, and outputs of a system that is also influenced by environmental factors such as COVID-19. The COVID-19 pandemic shifted many college students to different learning modes, changing their university experience. This study evaluated dietetics students' education experiences and characteristics in the latter period (spring 2022) of the COVID-19 pandemic using the systems approach. METHODS: Researchers developed and distributed an electronic survey to all 215 US-based Didactic Program in Dietetics (DPD) directors during March to May 2022 to forward to their students. Researchers calculated descriptive statistics for variables related to inputs, transformation process, and outputs in the systems approach. RESULTS: Respondents (n = 341) represented 51 DPDs in 31 states in the United States. Overall, DPD students (88.5%) were mostly or very satisfied with their choice of majoring in dietetics. Most (84.0%) planned to earn the RDN credential. Nearly half (46.9%) of DPD students were somewhat or extremely concerned about their readiness to continue their dietetics education path due to the pandemic-related learning conditions. Most students (43.6%) reported dissatisfaction with asynchronous remote instruction in laboratory courses. DPD students' GPAs remained consistent within the range of 3.75-4.0 from Fall 2019 (43.2%) to Spring 2022 (44.5%). The most important expectations of professors moving forward were to communicate effectively (97.3%), employ cultural humility (93.8%), eliminate discrimination in the classroom (93.6%), provide lecture slides (89.7%), and be flexible and accommodating (88.7%). CONCLUSIONS: DPD students emerged from COVID-19 with new perspectives and expectations for their university learning experience. Future research should explore the perspectives of DI directors, preceptors, and employers of COVID-19 era DPD graduates.


Assuntos
COVID-19 , Dietética , Humanos , Pandemias , Motivação , Estudantes , COVID-19/epidemiologia
6.
J Med Syst ; 48(1): 62, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38888610

RESUMO

Over the past decade, healthcare systems have started to establish control centres to manage patient flow, with a view to removing delays and increasing the quality of care. Such centres-here dubbed Healthcare Capacity Command/Coordination Centres (HCCCs)-are a challenge to design and operate. Broad-ranging surveys of HCCCs have been lacking, and design for their human users is only starting to be addressed. In this review we identified 73 papers describing different kinds of HCCCs, classifying them according to whether they describe virtual or physical control centres, the kinds of situations they handle, and the different levels of Rasmussen's [1] risk management framework that they integrate. Most of the papers (71%) describe physical HCCCs established as control centres, whereas 29% of the papers describe virtual HCCCs staffed by stakeholders in separate locations. Principal functions of the HCCCs described are categorised as business as usual (BAU) (48%), surge management (15%), emergency response (18%), and mass casualty management (19%). The organisation layers that the HCCCs incorporate are classified according to the risk management framework; HCCCs managing BAU involve lower levels of the framework, whereas HCCCs handling the more emergent functions involve all levels. Major challenges confronting HCCCs include the dissemination of information about healthcare system status, and the management of perspectives and goals from different parts of the healthcare system. HCCCs that take the form of physical control centres are just starting to be analysed using human factors principles that will make staff more effective and productive at managing patient flow.


Assuntos
Ergonomia , Humanos , Eficiência Organizacional , Atenção à Saúde/organização & administração , Gestão de Riscos/organização & administração , Fluxo de Trabalho
7.
Ergonomics ; 67(2): 168-181, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37309230

RESUMO

Road collision types repeat themselves, especially in low- and middle-income countries (LMICs), where countermeasures are often improvised and implemented with little planning. At the Shahbag intersection in Dhaka, Bangladesh, speed bumps were quickly constructed at the exit of the intersection as an improvised road safety measure following the occurrence of a fatal collision, which eventually contributed to another collision between a truck and a car. The events influencing the improvisation decision, and that action's consequences, have been analysed using the Impromap methodology, a variation of the Accimap approach that focusses specifically on improvisation. The applicability of the Impromap as a systems-based approach to the road safety domain is assessed using the predictions described in Rasmussen's risk management framework, and corresponding countermeasures are proposed. The analysis shows that improvisation in the road safety domain is undesirable irrespective of the economic setting as it is likely to eventually contribute to secondary collisions.Practitioner summary: In this paper, the events influencing the improvisation decision following a road crash, and that action's consequences, have been analysed using the Impromap methodology. The applicability of Impromap as a systems-based approach in road safety domain is assessed using the Rasmussen's risk management framework-based predictions, and corresponding countermeasures are proposed.


Assuntos
Acidentes de Trânsito , Veículos Automotores , Humanos , Acidentes de Trânsito/prevenção & controle , Bangladesh , Gestão de Riscos , Análise de Sistemas , Segurança
8.
Ergonomics ; 67(4): 482-497, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37199546

RESUMO

The Sustainable system-of-systems (SSoS) approach, complemented with econometric analysis was used to address China's decarbonisation problem, i.e. selecting fossil fuel consumption sources to be reduced in various regions to meet CO2 reduction targets with minimal effect on population and economic growth. In the SSoS, the micro-level system is represented by residents' health expenditure, the meso-level system by industry's CO2 emissions intensity, and the macro-level system by the government's achievement of economic growth. Regional panel data from 2009 to 2019 were used in an econometric analysis conducted using structural equation modelling. The results show that health expenditure was affected by CO2 emissions from the consumption of raw coal and natural gas. To support economic growth, the government should reduce raw coal consumption. For CO2 emissions reduction, industry in the eastern region should reduce raw coal consumption. The key advantage is SSoS with econometrics offers a way to reach a common goal among stakeholders.Practitioner summary: This research shows that the use of the SSoS approach, complemented with an econometric analysis of key social, economic, and natural capital data, can address a complex decarbonisation problem facing a nation (China, in the present case) while considering the goals of all stakeholders (the government, industrial communities, and residential communities).Abbreviations: CEADs: Carbon Emissions Accounts and Datasets for Emerging Countries; CEIC: CEIC Global Database; GRPS: World Economic Forum's Global Risks Perception Survey; HFE: human factors/ergonomics; ML-SEM: maximum likelihood estimation method; NDRC: National Development and Reform Commission of China; SEM: structural equation modelling; SSoS: Sustainable system-of-systems; TBL: triple bottom line.


Assuntos
Dióxido de Carbono , Combustíveis Fósseis , Humanos , Dióxido de Carbono/análise , Combustíveis Fósseis/análise , Carvão Mineral/análise , China , Análise de Sistemas
9.
Artigo em Inglês | MEDLINE | ID: mdl-39252483

RESUMO

BACKGROUND: Systems change approaches are increasingly adopted in public health to address complex problems. It is important that measures of systems change be developed so that the effects of systems change on health outcomes can be evaluated. Organisational practices are potential levers for systems change. However, robust measures of organisational capacity to engage in these practices are lacking. Informed by the Theory of Systems Change, we developed and tested the Capacity of Organisations for System Practices (COSP) scale. The COSP scale comprises four inter-related system practices within organisations-adaptation, alignment, collaboration and evidence-driven action and learning. METHODS: We applied a three-stage process: (1) Item generation; (2) Scale pre-testing; and (3) Structural analyses. Item response theory tests and semantic review, together with factor analytic techniques, were applied to refine the item set and determine the scale structure. RESULTS: An initial pool of 97 items was generated and pre-tested with six content experts and four target audience representatives. Modifications resulted in 60 items. In total, 126 participants provided data for the structural analysis. A second-order hierarchical four-factor model fit the data better than the more basic correlated factor model (Δχ2 = 1.758, p = .415). The fit indices for the final 31-item model were acceptable (RMSEA = .084, TLI = .819). CONCLUSIONS: The COSP scale is ready for further testing to ensure construct validity, stability and utility. SO WHAT?: Once validated, the Capacity of Organisations for System Practices (COSP) scale has the potential to advance the theory and practice of systems change approaches.

10.
Health Mark Q ; 41(1): 33-49, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37486187

RESUMO

Obesity is one of the highest metabolic risk factors associated with morbidity and mortality in the UK, with two-thirds of adults in the UK classed as overweight or obese. Whole systems approaches can be effective in tackling this public health challenge through stakeholder and key partner engagement. This article describes the co-design process for a social marketing obesity prevention campaign taking a whole systems approach based on the COM-B model of behaviour change. Development of social marketing campaigns through Agencies is often hampered by rapid turnaround and short timescales; we highlight how drawing on existing knowledge and co-design with beneficiaries can support the design, delivery and implementation of a social marketing behaviour change campaign.


Assuntos
Obesidade , Sobrepeso , Adulto , Humanos , Obesidade/prevenção & controle , Saúde Pública , Fatores de Risco , Marketing Social , Análise de Sistemas , Promoção da Saúde
11.
BMC Microbiol ; 23(1): 219, 2023 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-37573307

RESUMO

BACKGROUND: Anti-desiccant is a class of agrochemicals widely used to protect plants from water stresses, rapid temperature variations, heat and sunburn, frost and freeze damages, transplant shock, and pathogen and pest attack. Although anti-desiccants are generally considered non-toxic to organisms, it is unclear whether they may impact the phyllosphere microbial communities. In this study, three film-forming anti-desiccant products, TransFilm, Vapor Gard, and Wilt-Pruf were applied to the canopy of two boxwood cultivars 'Vardar Valley' and 'Justin Brouwers' on April 13 and August 26, 2021. Shoot samples were collected from boxwood plants treated with each of the three products, as well as nontreated control on June 16, August 26 (before the second treatment), and October 18. Microbial and plant genomic DNA was isolated together and 16S rRNA gene and the extended internal transcribed spacer regions were amplified with PCR and sequenced on a Nanopore MinION platform for bacterial and fungal identification. RESULTS: Bacterial communities were more diverse than fungal communities. At the phylum level, the boxwood phyllosphere was dominated by Proteobacteria and Ascomycota; at the genus level, Methylobacterium and Shiraia were the most abundant bacteria and fungi, respectively. Among the three film-forming anti-desiccants, Vapor Gard and Wilt-Pruf had more impact than TransFilm on the microbial communities. Specifically, broader impacts were observed on fungal than bacterial community composition and structure, with most affected fungi being suppressed while bacteria promoted. CONCLUSION: This study addressed several major knowledge gaps regarding boxwood phyllosphere microbiota and the impact of anti-desiccants on plant microbiome. We identified diverse microbial communities of boxwood, a major evergreen woody crop and an iconic landscape plant. We also found differential effects of three film-forming anti-desiccants on the composition and structure of bacterial and fungal communities. These findings advanced our understanding of the associated microbiome of this landmark plant, enabling growers to fully utilize the potentials of microbiome and three anti-desiccants in improving boxwood health and productivity.


Assuntos
Ascomicetos , Buxus , Microbiota , Buxus/genética , RNA Ribossômico 16S/genética , Microbiota/genética , Ascomicetos/genética , Plantas , Bactérias
12.
Int J Behav Nutr Phys Act ; 20(1): 111, 2023 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-37723534

RESUMO

BACKGROUND: Group Model Building (GMB) is a participatory system dynamics method increasingly used to address complex public health issues like obesity. GMB represents a set of well-defined steps to engage key stakeholders to identify shared drivers and solutions of a given problem. However, GMB has not yet been applied specifically to develop multi-duty interventions that address multiple inter-related issues such as malnutrition in all its forms (MIAIF). Moreover, a recent systematic review of empirical applications of a systems approach to developing obesity interventions found no published work from non-western, low- and middle-income countries (LMICs). In this paper we describe adaptations and innovations to a common GMB process to co-develop systemic MIAIF interventions with Chinese decision-makers. METHODS: We developed, piloted and implemented multiple cultural adaptations and two methodological innovations to the commonly used GMB process in Fang Cheng Gang city, China. We included formal, ceremonial and policy maker engagement events before and between GMB workshops, and incorporated culturally tailored arrangements during participant recruitment (officials of the same seniority level joined the same workshop) and workshop activities (e.g., use of individual scoring activities and hand boards). We made changes to the commonly used GMB activities which enabled mapping of shared drivers of multiple health issues (in our case MIAIF) in a single causal loop diagram. We developed and used a 'hybrid' GMB format combining online and in person facilitation to reduce travel and associated climate impact. RESULTS: Our innovative GMB process led to high engagement and support from decision-makers representing diverse governmental departments across the whole food systems. We co-identified and prioritised systemic drivers and intervention themes of MIAIF. The city government established an official Local Action Group for long-term, inter-departmental implementation, monitoring and evaluation of the co-developed interventions. The 'hybrid' GMB format enabled great interactions while reducing international travel and mitigating limitations of fully online GMB process. CONCLUSIONS: Cultural and methodological adaptations to the common GMB process for an Asian LMIC setting were successful. The 'hybrid' GMB format is feasible, cost-effective, and more environmentally friendly. These cultural adaptations could be considered for other Asian settings and beyond to address inter-related, complex issues such as MIAIF.


Assuntos
Desnutrição , População do Sudeste Asiático , Humanos , Povo Asiático , China , Desnutrição/epidemiologia , Desnutrição/etnologia , Desnutrição/prevenção & controle , Obesidade , Ásia Meridional
13.
Prev Med ; 177: 107727, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37848165

RESUMO

Implementation and sustaining impact of early childhood nutrition interventions in practice remains a challenge. An understanding of the extent to which determinants across multiple levels of the food system are being addressed may improve success. This literature review aimed to synthesise the evidence on interventions targeting dietary intake and eating behaviours in preschool children using a systems approach. Eligible studies included intervention studies targeting the dietary intake of preschool children aged 2-5 years in high income countries, published in English after January 2000. Interventions were categorised to the Determinants of Nutrition and Eating (DONE) framework for children developed and evaluated by experts across multiple fields. The framework maps and ranks 411 factors driving eating behaviours and nutrition and can be used to systematically summarise determinants. DONE ranks each determinant for its perceived research priority. A total of 160 eligible studies were identified. Most interventions targeted interpersonal (n = 101, 63.1%) and individual (n = 85, 53.1%) level determinants, with fewer targeting environmental (n = 55, 34.4%) and policy level (n = 17, 10.6%) determinants. The most frequently addressed determinants were Parental Resources and Risk Factors (n = 85) and Children's Food Knowledge, Skills and Abilities (n = 67). These determinants had a Moderate research priority rating. Home Food Availability and Accessibility at the environmental level is classified as the highest research priority, however, only 15 of 160 interventions addressed this determinant. This review highlights home food availability and accessibility as potential leverage points for future interventions to improve children's dietary intake and eating behaviours.


Assuntos
Ingestão de Alimentos , Alimentos , Pré-Escolar , Humanos , Estado Nutricional , Comportamento Alimentar , Pais , Dieta
14.
Br J Anaesth ; 131(2): 397-406, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37208283

RESUMO

We review the development of technology in anaesthesia over the course of the past century, from the invention of the Boyle apparatus to the modern anaesthetic workstation with artificial intelligence assistance. We define the operating theatre as a socio-technical system, being necessarily comprised of human and technological parts, the ongoing development of which has led to a reduction in mortality during anaesthesia by an order of four magnitudes over a century. The remarkable technological advances in anaesthesia have been accompanied by important paradigm shifts in the approach to patient safety, and we describe the inter-relationship between technology and the human work environment in the development of such paradigm shifts, including the systems approach and organisational resilience. A better understanding of emerging technological advances and their effects on patient safety will allow anaesthesia to continue to be a leader in both patient safety and in the design of equipment and workspaces.


Assuntos
Anestesia , Anestesiologia , Humanos , Inteligência Artificial , Segurança do Paciente , Anestesia/efeitos adversos , Salas Cirúrgicas
15.
Bioessays ; 43(3): e2000272, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33377530

RESUMO

Successful therapies to combat microbial diseases and cancers require incorporating ecological and evolutionary principles. Drawing upon the fields of ecology and evolutionary biology, we present a systems-based approach in which host and disease-causing factors are considered as part of a complex network of interactions, analogous to studies of "classical" ecosystems. Centering this approach around empirical examples of disease treatment, we present evidence that successful therapies invariably engage multiple interactions with other components of the host ecosystem. Many of these factors interact nonlinearly to yield synergistic benefits and curative outcomes. We argue that these synergies and nonlinear feedbacks must be leveraged to improve the study of pathogenesis in situ and to develop more effective therapies. An eco-evolutionary systems perspective has surprising and important consequences, and we use it to articulate areas of high research priority for improving treatment strategies.


Assuntos
Evolução Biológica , Ecossistema
16.
BMC Health Serv Res ; 23(1): 1360, 2023 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-38057835

RESUMO

BACKGROUND: Medication prescribing and discontinuation processes are complex and involve the patient, numerous health care professionals, organizations, health information technology (IT). CancelRx is a health IT that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing platform, theoretically improving communication. CancelRx was implemented across a Midwest academic health system in October 2017. The health system also operates 15 outpatient community pharmacies. OBJECTIVE: The goal of this qualitative study was to describe how both the clinic and community pharmacy work systems change and interact over time regarding medication discontinuations, before and after CancelRx implantation. APPROACH: Medical Assistants (n = 9), Community Pharmacists (n = 12), and Pharmacy Administrators (n = 3), employed by the health system were interviewed across 3-time periods between 2017 and 2018- 3-months prior to CancelRx implementation, 3-months after CancelRx implementation, and 9-months after CancelRx implementation. Interviews were audio recorded, transcribed, and conducted a hybrid analysis with deductive content analysis following the Systems Engineering Initiative for Patient Safety (SEIPS) framework and inductive analysis to capture additional codes and themes. KEY RESULTS: CancelRx changed the medication discontinuation process at both clinics and community pharmacies. In the clinics, the workflows and medication discontinuation tasks changed over time while MA roles and clinic staff communication practices remained variable. In the pharmacy, CancelRx automated and streamlined how medication discontinuation messages were received and processed, but also increased workload for the pharmacists and introduced new errors. CONCLUSIONS: This study utilizes a systems approach to assess disparate systems within a patient network. Future studies may consider health IT implications for systems that are not in the same health system as well as assessing the role of implementation decisions on health IT use and dissemination.


Assuntos
Serviços Comunitários de Farmácia , Farmácias , Farmácia , Humanos , Farmacêuticos , Pessoal de Saúde
17.
Health Res Policy Syst ; 21(1): 18, 2023 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-36864409

RESUMO

BACKGROUND: Complex systems approaches are increasingly used in health promotion and noncommunicable disease prevention research, policy and practice. Questions emerge as to the best ways to take a complex systems approach, specifically with respect to population physical activity (PA). Using an Attributes Model is one way to understand complex systems. We aimed to examine the types of complex systems methods used in current PA research and identify what methods align with a whole system approach as reflected by an Attributes Model. METHODS: A scoping review was conducted and two databases were searched. Twenty-five articles were selected and data analysis was based upon the following: the complex systems research methods used, research aims, if participatory methods were used and evidence of discussion regarding attributes of systems. RESULTS: There were three groups of methods used: system mapping, simulation modelling and network analysis. System mapping methods appeared to align best with a whole system approach to PA promotion because they largely aimed to understand complex systems, examined interactions and feedback among variables, and used participatory methods. Most of these articles focused on PA (as opposed to integrated studies). Simulation modelling methods were largely focused on examining complex problems and identifying interventions. These methods did not generally focus on PA or use participatory methods. While network analysis articles focused on examining complex systems and identifying interventions, they did not focus on PA nor use participatory methods. All attributes were discussed in some way in the articles. Attributes were explicitly reported on in terms of findings or were part of discussion and conclusion sections. System mapping methods appear to be well aligned with a whole system approach because these methods addressed all attributes in some way. We did not find this pattern with other methods. CONCLUSIONS: Future research using complex systems methods may benefit from applying the Attributes Model in conjunction with system mapping methods. Simulation modelling and network analysis methods are seen as complementary and could be used when system mapping methods identify priorities for further investigation (e.g. what interventions to implement or how densely connected relationships are in systems).


Assuntos
Análise de Dados , Projetos de Pesquisa , Humanos , Bases de Dados Factuais , Exercício Físico , Promoção da Saúde
18.
Am Nat ; 200(4): 486-505, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36150199

RESUMO

AbstractThe sexual ornamentation of animals typically consists of multiple distinct traits. The classical research approach focuses on differences among these traits, but this approach may often be misleading because of correlations among distinct sexual traits of similar origins. There are many published studies on the correlation structures of sexual traits, but the way receivers take into account the components of an integrated, multicomponent trait system remains mostly unknown. Here, we propose a general analytical framework to assess the possible sexual selection consequences of within-individual coherence in the expression of multiple correlated sexual traits. We then apply this framework to a long-term mutual plumage coloration data set from a wild bird population. The results suggest that the coherence of component plumage color traits is not sexually selected. However, component trait coherence affects sexual selection on integrated plumage color. When assessing across-spectrum plumage reflectance, receivers choosing mates apparently disregard a component trait if it is inconsistent with the overall expression of other components. This indicates that separately examining and manipulating distinct sexual traits may often be misleading. Theoretical and empirical studies should further explore the effects of coherence on the ornament-preference coevolution.


Assuntos
Plumas , Seleção Sexual , Animais , Pigmentação , Reprodução , Caracteres Sexuais , Comportamento Sexual Animal
19.
Int J Behav Nutr Phys Act ; 19(1): 53, 2022 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-35549726

RESUMO

BACKGROUND: Active recreation contributes to child and adolescent physical activity, however, factors affecting uptake are poorly understood at the systems level. The aims of this study were: (1) to use systems analysis methods to understand youth active recreation in Victoria, Australia, (ii) identify potential system leverage points to enhance active recreation, and (iii) explore stakeholder views of systems analysis methods for informing practice and policy decision-making. METHODS: Phase 1: Umbrella review of systematic reviews (2013-2018), synthesising evidence for correlates, determinants and intervention evidence for promoting active recreation. Phase 2: Development of three systems models (ActorMap and two ActivMaps), depicting active recreation actors/organisations, correlates, determinants and intervention evidence. Phase 3: Development of causal loop diagrams (CLDs) and identification of leverage points based on the Action Scales Model. Phase 4: Model feedback via stakeholder interviews (n = 23; 16 organisations). RESULTS: From the literature, 93 correlates and determinants, and 49 intervention strategies were associated with child and adolescent active recreation; the majority located at a social or individual level. Ten potential system leverage points were identified in the CLDs, which differed for pre-schoolers versus children and adolescents. Only time outdoors (an event leverage point) emerged for all age groups. Changes to the built and natural environment (i.e., land use planning, urban design) as a complete domain was a key structural leverage point for influencing active recreation in children and adolescents. Subject matter experts and stakeholder interviews identified 125 actors operating across seven hierarchical active recreation system levels in Victoria. Stakeholder interviews identified 12 areas for future consideration and recommendations for practice/policy influence. CONCLUSIONS: Our findings underscore the need for dynamic models of system behaviour in active recreation, and to capture stakeholder influence as more than a transactional role in evidence generation and use. Effective responses to youth inactivity require a network of interventions that target specific leverage points across the system. Our models illustrate areas that may have the greatest system-level impact, such as changes to the built and natural environment, and they provide a tool for policy, appraisal, advocacy, and decision-making within and outside of government.


Assuntos
Formulação de Políticas , Recreação , Adolescente , Criança , Humanos , Revisões Sistemáticas como Assunto , Análise de Sistemas , Vitória
20.
BMC Med Res Methodol ; 22(1): 72, 2022 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-35300619

RESUMO

BACKGROUND: Systems approaches are currently being advocated and implemented to address complex challenges in Public Health. These approaches work by bringing multi-sectoral stakeholders together to develop a collective understanding of the system, and then to identify places where they can leverage change across the system. Systems approaches are unpredictable, where cause-and-effect cannot always be disentangled, and unintended consequences - positive and negative - frequently arise. Evaluating such approaches is difficult and new methods are warranted. METHODS: Ripple Effects Mapping (REM) is a qualitative method which can capture the wider impacts, and adaptive nature, of a systems approach. Using a case study example from the evaluation of a physical activity-orientated systems approach in Gloucestershire, we: a) introduce the adapted REM method; b) describe how REM was applied in the example; c) explain how REM outputs were analysed; d) provide examples of how REM outputs were used; and e) describe the strengths, limitations, and future uses of REM based on our reflections. RESULTS: Ripple Effects Mapping is a participatory method that requires the active input of programme stakeholders in data gathering workshops. It produces visual outputs (i.e., maps) of the programme activities and impacts, which are mapped along a timeline to understand the temporal dimension of systems change efforts. The REM outputs from our example were created over several iterations, with data collected every 3-4 months, to build a picture of activities and impacts that have continued or ceased. Workshops took place both in person and online. An inductive content analysis was undertaken to describe and quantify the patterns within the REM outputs. Detailed guidance related to the preparation, delivery, and analysis of REM are included in this paper. CONCLUSION: REM may help to advance our understanding and evaluation of complex systems approaches, especially within the field of Public Health. We therefore invite other researchers, practitioners and policymakers to use REM and continuously evolve the method to enhance its application and practical utility.


Assuntos
Exercício Físico , Saúde Pública , Humanos , Pesquisadores
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